title: Age--an independent prognostic factor of clinical outcome in renal malignancies: results of a large study over two decades.
abstract: OBJECTIVE
  Age has been linked to outcome in renal cancer patients, but mainly in North American cohorts. In this study, we hypothesized that age is correlated with metastasis and cancer-specific survival in a German cohort regardless of types of treatments.
  
  
  METHODS
  A total of 1,538 patients treated for renal malignancies between 1991 and 2010 were evaluated. Mean age and median age are 61.9 ± 11.6 and 62.6 years. Clinicopathologic [tumor type, size, grade, stage and treatment (surgery, chemotherapy, radiation, immunotherapy)] and outcome parameters (metastasis and survival) were examined for an association with age using logistic regression and Cox proportional hazard model, and Kaplan-Meier plots.
  
  
  RESULTS
  Age was associated with stage, metastasis, treatment, cancer-specific and overall mortality (p < 0.01). The metastasis-free and cancer-free survival rates for patients >63 years were lower than those for patients ≤63 years (p < 0.0001). In a multivariate analysis, age was an independent prognostic factor of metastasis, cancer-specific and overall mortality (p < 0.0001) even when data were stratified in different decades and treatment was included as one of the parameters. Patients >63 years of age had 29-35% higher risk of metastasis and cancer-specific mortality than younger patients. Median metastasis-free and cancer-specific survival for patients >63 years of age (months: 84.4; 70.3) was ~50% shorter than in patients ≤63 years (months: 151; 144.6).
  
  
  CONCLUSIONS
  This large study shows that, despite advances in surgical and non-surgical treatment modalities over the two decades, age is an independent prognostic indicator of metastasis and cancer-specific mortality in renal cancer patients. Patients >63 years have ~30% increased risk for metastasis and ~50% shorter cancer-specific survival.
authors.affiliation: Department of Urology and Urologic Oncology, Hannover Medical School (OE 6240), Carl-Neuberg-Str. 1, 30625, Hannover, Germany, marie.ch.hupe@googlemail.com.
authors.forename: Marie C
authors.initials: MC
authors.lastname: Hupe
authors.forename: Axel S
authors.initials: AS
authors.lastname: Merseburger
authors.forename: Vinata B
authors.initials: VB
authors.lastname: Lokeshwar
authors.forename: Hendrik
authors.initials: H
authors.lastname: Eggers
authors.forename: Hendrik
authors.initials: H
authors.lastname: Rott
authors.forename: Gerd
authors.initials: G
authors.lastname: Wegener
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abbas
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kuczyk
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Herrmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult